By Gareth Iacobucci
Three in four GPs believe redesigning care pathways using QOF indicators is ‘not feasible’, amid fears that the new quality and productivity targets will pile a major new administrative burden on practices.
A Pulse survey of more than 200 GPs reveals widespread concern about the indicators, introduced as part of this year’s GP contract to incentivise a reduction in prescribing, secondary care outpatient referrals and emergency admissions.
Full details released last week lay bare the administrative challenge facing GPs, with practices required to agree areas to focus on with managers, carry out external peer reviews in groups of at least six practices and produce progress reports.
Practices must internally review prescribing to assess clinical and cost-effectiveness, then agree with their primary care organisation three areas for improvement by June. They will be paid according to the percentage of prescriptions complying with each of the three agreed plans, with achievement measured ‘against a sliding scale’.
The guidance states that the maximum percentage ‘should normally be set at the 75th centile of national achievement’, but could be lower if agreed locally. The minimum threshold will be set 20 percentage points below the maximum threshold.
GPs will also be required to group with other local practices to conduct external peer reviews of outpatient referral data, to determine reasons for any variances and propose areas for service design improvements.
PCOs will lead the development of care pathways, working with practice groups and the LMC, but all practices must submit a report setting out ‘the changes in patterns of referrals that have resulted’ by the end of March 2012. For the emergency admission indicators, GPs must agree three new care pathways and produce a report of the changes to admission rates.
GPC deputy chair Dr Richard Vautrey insisted the new indicators should be achievable for most practices, and said the prescribing indicators would be ‘straightforward’.
But Dr Mark Smith, a GP in Ferndown, Dorset, said: ‘What happened to the contract we signed in 2004? The ‘‘low bureaucracy, high-trust” contract has been broken.’
Dr Bill Beeby, chair of the GPC’s clinical and prescribing subcommittee, said: ‘Even practices in the top quartile are going to have to work hard to maintain their position.’